Diagnosing and Assessing Treatment Options for Patients with Transplant-Not Preferred NDMM
Dr Alsina outlines criteria used in determining transplant eligibility and her approach to assessing standard risk versus high-risk in patients with NDMM.
Case: A 77-Year-Old Man with Transplant-Not Preferred Newly Diagnosed Multiple Myeloma (NDMM)
Patient KR is a 77 y/o man.
- PMH: T2DM, hypertension, and COPD
- SMH: Does not smoke; drinks occasionally in social settings.
Clinical Presentation:
- In January 2023, KR visited his PCP for his annual checkup. He reported having persistent bone pain and increased fatigue.
Clinical Workup and Diagnosis:
- Calcium 12.5 mg/dL
- CrCl, 40 mL/min
- Hgb, 9.8 g/dL
- β-2 microglobulin, 7.8 mg/L
- Albumin, 3.4 g/dL
- LDH wnl
- sFLC lambda at diagnosis, 1700 mg/L
- Bone marrow showed 40% clonal plasma cells LLC restricted-Clonose Id obtained.
- del(17p) abnormality detected by FISH.
- PET-CT showed osteolytic lesions in several ribs; no extramedullary disease (EMD).
- ECOG PS 2
- IMWG Frailty Status: Intermediate-Frail
- KR was diagnosed with ISS III/R-ISS stage III lambda LC multiple myeloma; determined to be transplant-not preferred based on age and comorbidities.
Current Treatment:
- After discussions with his family and clinical team, KR was initiated on Daratumumab/lenalidomide/dexamethasone (D-Rd).
- Patient achieved complete response (CR).
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